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Neonatal Conjunctivitis


Neonatal Conjunctivitis


حالة سريرية

الوصف الكامل Background

A 28-year-old woman gave birth to a full-term male infant weighing 4.1 kg. The labor and delivery were unremarkable, and the infant and mother were discharged home 2 days postpartum. At day 4, the mother brings the baby to the pediatrician, complaining that he has red eyes. Physical examination reveals red eyes and bilateral mucopurulent discharge. The mother explains that the discharge seemed to "pour out of his eyes" when she first opened his lids, but now it just seems to be constant. On examination, both of the baby's eyes are moderately injected with a definite purulent discharge. His corneas are clear and his pupils react normally.

كتابة حرة وطرح موضوع النقاش!


What is the most likely cause of neonatal conjunctivitis in this infant?

Chemical (sterile) conjunctivitis
Chlamydia trachomatis
Haemophilus influenzae
Neisseria gonorrhoeae
Staphylococcus aureus
المرجع

Medscape

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kandy
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أظن: التهاب ملتحمة بالمكورات البنية باعتبار أن الإصابة حدثت خلال 5 أيام من الولادة Rolling Eyes
بالنسبة للكلاميديا (التراخوم أو التهاب الملتحمة الاندخالي) يحتاج مدة أطول وما بيتظاهر بهالإفرازات
والمستدمية النزلية عند الأطفال تتظاهر أيضاً بالتهاب سحايا أو ذات رئة
بالنسبة لل staph aureus هي أشيع الأسباب الجرثومية لالتهاب الملتحمة بس ما بعرف إذا ممكن تعمل المظهر اللي بالصورة Rolling Eyes

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Dr.TH


Chlamydia trachomatis Eye-wink

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Tariq1987
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الكلاميديا بتتظاهر بهالافرازات وأكتر .. وهي أشيع العضويات التي تصيب عين الوليد

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Tariq1987
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برافو طارق Very Happy الكلاميديا
Most Common Pathogens Associated With Ophthalmia Neonatorum

Chlamydia trachomatis
Neisseria gonorrhoeae
Staphylococcus aureus
Herpes simplex
Haemophilus influenzae
Streptococcus pneumoniae

Quote:
أظن: التهاب ملتحمة بالمكورات البنية باعتبار أن الإصابة حدثت خلال 5 أيام من الولادة

و أنا كمان هيك فكرت بالأول بس الجواب هوي الكلاميديا
Chlamydial conjunctivitis typically presents with irritated red eye and mucopurulent unilateral or bilateral discharge in the first week after birth, although it can occur earlier if the amniotic membranes rupture prematurely.[3,6] Along with corneal involvement, pain and photophobia can be part of the inflammatory process. Although usually mild, severe exudative conjunctivitis may occur, along with the development of a persistent follicular conjunctivitis.[1,3] Overall, the symptoms of chlamydial conjunctivitis are usually milder than would be expected from the appearance of the eye.

Neisseria gonorrhoeae is a rare cause of neonatal conjunctivitis.[6] The onset of conjunctivitis due to N gonorrhoeae is usually earlier (ie, the first week of life) than that seen with chlamydial infection. In addition, gonococcal conjunctivitis typically presents as hyperpurulent bilateral discharge.[7] Because infection may result in corneal involvement and perforation and blindness, there is a need for prompt treatment. It is estimated that the risk of scarring and blindness ranges from 1% to 16%.[7] The prevalence of neonatal gonococcal conjunctivitis has been markedly reduced with routine antibiotic prophylaxis at birth. Currently, the Centers for Disease Control and Prevention (CDC) recommends prophylactic topical antibiotics (erythromycin) to all newborn infants to prevent gonococcal ophthalmia neonatorum.[
Other organisms less commonly associated with neonatal conjunctivitis include Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae. Staphylococcal conjunctivitis is typically acquired in the neonatal unit and is characterized by a purulent discharge and to a lesser extent by redness.[3] H influenzae and S pneumoniae can be easily identified with Gram stain and culture of the conjunctival exudate

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kandy
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Based on the infant's age (4 days) and presentation (bilateral, mucopurulent discharge), the pediatrician suspects chlamydial conjunctivitis.

Perform a culture and Gram stain
Prescribe a broad-spectrum topical antibiotic
Prescribe systemic antibiotics
Refer to an ophthalmologist

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kandy
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أنا اعتمدت على هالمعلومة، وعلى كتابنا

Quote:
The incubation period for Chlamydia conjunctivitis is 5 to 14 days after delivery. Presentation before five days is unusual but has been reported to occur earlier in infants born to mothers with premature rupture of the membranes

على كل شكراً للتوضيح Eye-wink

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Dr.TH

Quote:
أظن: التهاب ملتحمة بالمكورات البنية باعتبار أن الإصابة حدثت خلال 5 أيام من الولادة

ع كل حال بيبقى هاد الاحتمال وارد بقوة Eye-wink
لذلك لازم نعمل Perform a culture and Gram stain
مو Rolling Eyes

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Tariq1987
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Quote:
ع كل حال بيبقى هاد الاحتمال وارد بقوة Eye-wink
لذلك لازم نعمل Perform a culture and Gram stain
مو

تماما ....

[/eng]

Because of the potential for serious sequelae with certain organisms in the neonatal period (ie, C trachomatis, N gonorrhoeae), all
neonates presenting with conjunctivitis should have a thorough examination and culture and Gram stain performed. Prompt and accurate therapy can be instituted based on the results.

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Quote:
أنا اعتمدت على هالمعلومة، وعلى كتابنا
اقتباس:
The incubation period for Chlamydia conjunctivitis is 5 to 14 days after delivery. Presentation before five days is unusual but has been reported to occur earlier in infants born to mothers with premature rupture of the membranes

و انا كمان هيك بعرف انو لحد اليوم الخامس منقول البنيات

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kandy
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The pediatrician takes a Gram stain and culture, and it comes back positive for C trachomatis.

What is the appropriate treatment for neonatal chlamydial conjunctivitis?

Ceftriaxone intravenous/intramuscular
Oral cephalosporin for 7 days
Oral erythromycin for 14 days
Topical fluoroquinolones

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kandy
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Oral erythromycin for 14 days

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Tariq1987
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Quote:
اقتباس:
أنا اعتمدت على هالمعلومة، وعلى كتابنا
اقتباس:
The incubation period for Chlamydia conjunctivitis is 5 to 14 days after delivery. Presentation before five days is unusual but has been reported to occur earlier in infants born to mothers with premature rupture of the membranes

و انا كمان هيك بعرف انو لحد اليوم الخامس منقول البنيات

انا ماكنت بعرف هالمعلومة !!
معناتا رب رمية من غير رام Nerd

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Tariq1987
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أنا كمان بمشي مع الخيار: Oral erythromycin for 14 days
بكتابنا لمدة 8 أيام إذا التهاب ملتحمة اندخالي
السيفالوسبورينات للبنيات

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Dr.TH

Quote:
Oral erythromycin for 14 days
أنا كمان بمشي مع الخيار:

Oral erythromycin for 14 days

تماما

Topical treatment may effectively treat the eye, but it will not combat systemic infections. Therefore, because C trachomitis is usually systemic -- and may progress to pneumonia -- babies must be treated with oral therapy. The recommended dose is the same as that for chlamydial pneumonia (ie, oral erythromycin 50 mg/kg, in 4 divided doses, for 14 days). An option for infants aged 1 month or older is oral sulfisoxazole 150 mg/kg/day divided into 4- to 6-hour doses. Because the efficacy of erythromycin is only 80%, retreatment may be required

Quote:
السيفالوسبورينات للبنيات

صح

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